DO NOT STAPLE
Form 8966-C
(Rev. December 2016)
Department of the Treasury
Internal Revenue Service
Cover Sheet for Form 8966 Paper Submissions
OMB No. 1545-2246
Name of filer
Taxpayer Identification Number (TIN)
Global Intermediary Identification Number (GIIN)
. . .
Number, street, and room or suite no.
City or town, state or province, country, and ZIP or foreign postal code
1 Type of paper Forms 8966 attached (check only one box): Original Amended Corrected Voided
2
Number of paper Forms 8966 attached
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Caution: Please ensure only one box is checked on line 1. If this transmittal is submitting corrected, amended, or voided
reports, please ensure all attached Forms 8966 submitted under this cover sheet are correctly marked and consistent
with the box checked on line 1.
Please return this entire page to the Internal Revenue Service.
Sign
Here
I declare that I have examined this return and accompanying documents and, to the best of my knowledge and belief, they are true,
correct, and complete.
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Your signature Title Date Daytime phone number
Instructions
Purpose of form. Use this form to transmit paper Forms 8966,
FATCA Report, to the Internal Revenue Service. Use a separate
Form 8966-C to transmit each type of Form 8966 (see the
instructions for line 1).
Electronic filing requirement. Unless you have a hardship
waiver, you must file Forms 8966 electronically. If you submit
Forms 8966 electronically, do not use Form 8966-C.
Where and when to file. Send Form 8966-C (and the paper
Forms 8966 being transmitted) to:
Internal Revenue Service
FATCA, Stop 6052 AUSC
3651 South IH 35
Austin, Texas 78741
Send Form 8966-C and paper Forms 8966 by the due date
specified in the instructions for Form 8966.
Identifying information at top of form. The identifying
information of the filer named on this form must be the same as
the information entered on Forms 8966. If you have been
assigned a GIIN by the IRS, enter that number on the line for
GIIN. If you do not have a GIIN, enter your EIN on the line for
TIN.
Line 1. Check the box for the type of paper Forms 8966
(original, amended, corrected, or voided) you are transmitting.
Check only one box. Each type must be transmitted with a
separate Form 8966-C. See the Instructions for Form 8966 for
when to file an amended, corrected, or voided Form 8966.
Line 2. Enter the number of paper Forms 8966 attached to the
Form 8966-C. Please ensure all attached Forms 8966 submitted
under this cover sheet are correctly marked and consistent with
the box checked on line 1.
Paperwork Reduction Act Notice. The time needed to
complete and file this form will vary depending on individual
circumstances. The estimated average time is 7 minutes.
For Paperwork Reduction Act Notice, see Form 8966.
Cat. No. 67369U
Form 8966-C (Rev. 12-2016)
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